How We Grade Nursing Homes
Our complete methodology — updated quarterly with each new CMS data release.
🔒 Editorial independence: NursingHomeGrader accepts no payment from nursing homes, placement agencies, or any entity that could influence our grades. Our methodology is published in full so anyone can verify our work.
Data Source
All grades are derived from the CMS (Centers for Medicare & Medicaid Services) Nursing Home Care Compare dataset, which is publicly available and updated quarterly. CMS collects this data through on-site inspections, payroll-based staffing records, and quality measure calculations based on resident health assessments (MDS submissions).
The Three Components
Our overall grade combines three weighted components:
| Component | Weight | What It Measures |
|---|---|---|
| Health Inspections | 35% | Deficiency counts, scope & severity ratings, citation history over 3 years, complaint inspections |
| Staffing Levels | 30% | RN hours per resident per day, total nursing hours, weekend staffing, staff turnover rate |
| Quality Measures | 35% | Hospital readmissions, pressure ulcer rates, fall rates, flu vaccination, antipsychotic medication use |
Grading Scale
| Grade | Score Range | Interpretation |
|---|---|---|
| A | 85–100 | Excellent — top 8% nationally |
| B | 70–84 | Good — above average performance |
| C | 55–69 | Average — meets minimum standards |
| D | 40–54 | Below average — significant concerns |
| F | 0–39 | Failing — serious deficiencies, consider alternatives |
Why We're Better Than the CMS 5-Star System
Update Frequency
We recalculate all 15,000 grades within 30 days of each quarterly CMS data release. The current data reflects inspections through late 2024.
Limitations
Our grades are based entirely on publicly available CMS data. We cannot verify whether CMS data accurately reflects day-to-day care. Families should use our grades as a starting point, then visit facilities in person and speak with current residents and staff.